Animal Care Centers of NYC Owner Surrender Questionnaire

Thank you for contacting Animal Care Centers of NYC. If you are having difficulty keeping your animal, please fill out the following questionnaire. An Admissions Counselor will contact you within 2 to 3 business days to discuss the best options for you and your pet.

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1.Contact Information

Full Name

Address

Apt

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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2.What is the best time of day to contact you?

Morning (8AM-11AM)

Afternoons (12PM-4PM)

Evenings (4PM-7PM)

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3.Pet(s) Name(s)

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4.Age(s)

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5.Type of Animal(s)

Cat

Dog

Rabbit

Other (please specify)

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6.Breed(s)

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7.Is your pet spayed or neutered?

Yes

No

I am not sure

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8.How many animals are you interested in surrendering in total?

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9.What challenges are you having with your pet(s)?

Pet medical emergency

Private landlord conflict

NYCHA conflict

Moving

Eviction

Allergies

Pet behavior-Potty accidents

Pet behavior-destructive (scratching/chewing furniture, etc.)

Pet behavior-aggression (biting people or animals)

Owner emergency (domestic violence, homeless, hospital, fire, flood)

Owner health

Cost (spay/neuter, vaccines, food, etc.)

No time

Other

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10.Why are you interested in surrendering you animal(s)? Please be as detailed as possible so our Admissions Counselors can provide you with the best option(s) for you and your pet(s).

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11.If provided with a solution to the challenges you mentioned above, would you be interested in keeping your pet?